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Huang X, Zheng S, Chen P, Zhu M, Guo J, Li Q, Zeng K, He S. Effective treatment of corticosteroid-induced facial erythema using fractional radiofrequency microneedling. Lasers Surg Med 2024; 56:466-473. [PMID: 38693708 DOI: 10.1002/lsm.23787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES To investigate the efficacy of Fractional Radiofrequency Microneedling (FRM) in treating corticosteroid-induced facial erythema. METHODS A retrospective study was conducted involving eight patients diagnosed as corticosteroid-induced facial erythema. Each patient underwent a single session of FRM. Evaluative measures included Clinician's Erythema Assessment (CEA), Patient's Self-Assessment (PSA), assessment of telangiectasia severity, procedure-associated pain (10-point scale), patient satisfaction (3-point scale) and secondary outcomes. RESULTS The study found a 75% success rate and 100% effectiveness rate in alleviating erythema symptoms. CEA and PSA scores decreased by 67.7% and 78.1%, respectively. No cases of erythema rebound were recorded during the 3-month follow-up period. CONCLUSIONS FRM demonstrated effectiveness and safety in treating facial erythema, offering promising advancement in dermatologic therapeutics.
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Affiliation(s)
- Xiaowen Huang
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Siqi Zheng
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pingjiao Chen
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Menghua Zhu
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jia Guo
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qian Li
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kang Zeng
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sijin He
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Han JY, Lee YJ, Lim DW, Jung HJ, Kwon E, Hong J, Lee YM. Cheungsam Seed Husk Extract Reduces Skin Inflammation through Regulation of Inflammatory Mediator in TNF-α/IFN-γ-Induced HaCaT Cells. PLANTS (BASEL, SWITZERLAND) 2024; 13:1704. [PMID: 38931136 PMCID: PMC11207521 DOI: 10.3390/plants13121704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/31/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
Cannabis contains numerous natural components and has several effects such as anticancer, anti-inflammatory and antioxidant. Cheungsam is a variety of non-drug-type hemp, developed in Korea and is used for fiber (stem) and oil (seed). The efficacy of Cheungsam on skin is not yet known, and although there are previous studies on Cheungsam seed oil, there are no studies on Cheungsam seed husk. In this study, we investigated the potential of Cheungsam seed husk ethanol extract (CSSH) to alleviate skin inflammation through evaluating the gene and protein expression levels of inflammatory mediators. The results showed that CSSH reduced pro-inflammatory cytokines (IL-1β, IL-6, IL-8, MCP-1 and CXCL10) and atopic dermatitis-related cytokines (IL-4, CCL17, MDC and RANTES) in TNF-α/IFN-γ-induced HaCaT cells. Furthermore, ERK, JNK and p38 phosphorylation were decreased and p-p65, p-IκBα, NLRP3, caspase-1, p-JAK1 and p-STAT6 were suppressed after CSSH treatment. CSSH significantly increased the level of the skin barrier factors filaggrin and involucrin. These results suggest that Cheungsam seed husk ethanol extract regulates the mechanism of skin inflammation and can be used as a new treatment for skin inflammatory diseases.
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Affiliation(s)
- Ji-Ye Han
- Department of Oriental Pharmacy, College of Pharmacy and Wonkwang-Oriental Medicines Research Institute, Wonkwang University, Iksan 54538, Republic of Korea; (J.-Y.H.); (Y.J.L.); (D.-W.L.); (H.-J.J.)
| | - Yun Jung Lee
- Department of Oriental Pharmacy, College of Pharmacy and Wonkwang-Oriental Medicines Research Institute, Wonkwang University, Iksan 54538, Republic of Korea; (J.-Y.H.); (Y.J.L.); (D.-W.L.); (H.-J.J.)
| | - Do-Won Lim
- Department of Oriental Pharmacy, College of Pharmacy and Wonkwang-Oriental Medicines Research Institute, Wonkwang University, Iksan 54538, Republic of Korea; (J.-Y.H.); (Y.J.L.); (D.-W.L.); (H.-J.J.)
| | - Hyun-Ju Jung
- Department of Oriental Pharmacy, College of Pharmacy and Wonkwang-Oriental Medicines Research Institute, Wonkwang University, Iksan 54538, Republic of Korea; (J.-Y.H.); (Y.J.L.); (D.-W.L.); (H.-J.J.)
| | - EunJeong Kwon
- College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea; (E.K.); (J.H.)
| | - Jongki Hong
- College of Pharmacy, Kyung Hee University, Seoul 02447, Republic of Korea; (E.K.); (J.H.)
| | - Young-Mi Lee
- Department of Oriental Pharmacy, College of Pharmacy and Wonkwang-Oriental Medicines Research Institute, Wonkwang University, Iksan 54538, Republic of Korea; (J.-Y.H.); (Y.J.L.); (D.-W.L.); (H.-J.J.)
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3
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Chu AWL, Rayner DG, Chu X, Chen L, Dong AYH, Waserman S, Baker DR, Sheikh J, Moellman J, Lang DM, Ben-Shoshan M, Mathur SK, Beck LA, Khan DA, Oliver ET, Asiniwasis RN, Chan J, Cole EF, Trayes KP, Frazier WT, Runyon L, Wheeler KE, Eftekhari S, Gardner DD, Winders T, Bernstein JA, Saini SS, Chu DK. Topical corticosteroids for hives and itch (urticaria): Systematic review and Bayesian meta-analysis of randomized trials. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00348-X. [PMID: 38901542 DOI: 10.1016/j.anai.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Topical corticosteroids are widely used as a treatment for itch and wheals (urticaria), but their benefits and harms are unclear. OBJECTIVE To systematically synthesize the benefits and harms of topical corticosteroids for the treatment of urticaria. METHODS We searched MEDLINE, EMBASE, and CENTRAL from database inception to March 23, 2024, for randomized trials comparing topical corticosteroids with placebo for patients with urticaria (either chronic spontaneous or inducible urticaria or acute urticaria elicited from skin/intradermal allergy testing). Paired reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects meta-analyses addressed urticaria severity, itch severity (numeric rating scale; range 0-10; higher is worse), and adverse events. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed certainty of evidence ratings. PROSPERO registration: CRD42023455182. RESULTS A total of 19 randomized controlled trials enrolled 379 participants with a median of mean age of 30.1 (range 21.1-44.0) years. Compared with placebo, topical corticosteroids may reduce wheal size (ratio of means 0.47, 95% CI 0.38-0.59; low certainty) and itch severity (mean difference -1.30, 95% CI -5.07 to 2.46; very low certainty). Topical corticosteroids result in little to no difference in overall adverse events (94 fewer patients per 1000, 95% credible intervals 172 fewer to 12 more; high certainty). CONCLUSION Compared with placebo, topical corticosteroids may result in a reduction of wheal size and little to no difference in overall adverse events. Topical corticosteroids may reduce itch severity, but the evidence is very uncertain. Future large, randomized trials addressing the use of topical corticosteroids would further support optimal urticaria management.
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Affiliation(s)
- Alexandro W L Chu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada
| | - Daniel G Rayner
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Xiajing Chu
- Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lina Chen
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada
| | - Audrey Y H Dong
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada
| | - Susan Waserman
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Diane R Baker
- Department of Dermatology, Oregon Health & Sciences University, Portland, Oregon
| | - Javed Sheikh
- Department of Clinical Immunology and Allergy, Southern California Permanente Medical Group, Los Angeles, California
| | - Joseph Moellman
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
| | - Moshe Ben-Shoshan
- Division of Allergy, Immunology and Dermatology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Sameer K Mathur
- Division of Allergy, Pulmonary and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Eric T Oliver
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel N Asiniwasis
- Division of Dermatology, Department of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Jeffrey Chan
- Emergency Medicine, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Emily F Cole
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Kathryn P Trayes
- Department of Family and Community Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Winfred T Frazier
- Department of Family Medicine, UPMC St. Margaret, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Lauren Runyon
- Division of Allergy and Immunology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kathryn E Wheeler
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Sanaz Eftekhari
- Asthma and Allergy Foundation of America, Arlington, Virginia
| | | | - Tonya Winders
- Global Allergy & Airways Patient Platform, Vienna, Austria
| | - Jonathan A Bernstein
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sarbjit S Saini
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Derek K Chu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada; The Research Institue of St. Joe's Hamilton, Hamilton, Ontario, Canada.
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De Simoni E, Candelora M, Belleggia S, Rizzetto G, Molinelli E, Capodaglio I, Ferretti G, Bacchetti T, Offidani A, Simonetti O. Role of antioxidants supplementation in the treatment of atopic dermatitis: a critical narrative review. Front Nutr 2024; 11:1393673. [PMID: 38933878 PMCID: PMC11203398 DOI: 10.3389/fnut.2024.1393673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by itching, epidermal barrier dysfunction, and an unbalanced inflammatory reaction. AD pathophysiology involves a dysregulated immune response driven by T helper-2 cells. Many factors, including reactive oxygen species (ROS), are involved in AD pathogenesis by causing cellular damage and inflammation resulting in skin barrier dysfunction. This narrative review aims to provide a comprehensive overview of the role of natural molecules and antioxidant compounds, highlighting their potential therapeutic value in AD prevention and management. They include vitamin D, vitamin E, pyridoxine, Vitamin C, carotenoids, and melatonin. Some studies report a statistically significant association between antioxidant levels and improvement in AD, however, there are conflicting results in which antioxidant supplementation, especially Vitamin D, did not result in improvement in AD. Therefore, the clinical efficacy of these dietary nutritional factors in the treatment of AD needs to be further evaluated in clinical trials. Meanwhile, antioxidants can be incorporated into the management of AD patients in a personalized manner, tailored to the severity of the disease, comorbidities, and individual needs.
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Affiliation(s)
- Edoardo De Simoni
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Matteo Candelora
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Sara Belleggia
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Giulio Rizzetto
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Elisa Molinelli
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Irene Capodaglio
- Hospital Cardiology and UTIC, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Gianna Ferretti
- Department of Clinical Experimental Science and Odontostomatology-Biochemistry, Research Center of Health Education and Health Promotion, Ancona, Italy
| | - Tiziana Bacchetti
- Department of Life and Environmental Sciences-Biochemistry, Polytechnic University of Marche, Ancona, Italy
| | - Annamaria Offidani
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Oriana Simonetti
- Clinic of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
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5
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Barlow R, Proctor A, Moss C. Topical steroid withdrawal: a survey of UK dermatologists' attitudes. Clin Exp Dermatol 2024; 49:607-611. [PMID: 38320214 DOI: 10.1093/ced/llae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/28/2023] [Accepted: 01/11/2024] [Indexed: 02/08/2024]
Abstract
The term topical steroid withdrawal (TSW) refers to a condition widely discussed on social media, but rarely mentioned in the medical literature. It typically involves a patient with chronic eczema who abruptly discontinues topical corticosteroids (TCS) believing they are ineffective and damaging. Symptoms include an acute eruption, worse than the previous eczema, of painful erythema followed by oozing, crusting, desquamation and sometimes prolonged systemic weakness. Patients self-diagnose and often avoid healthcare professionals who dismiss the diagnosis and persist in offering TCS, leaving them unsupported. We analysed 121 responses to a survey of UK dermatologists' attitudes to TSW. Views on aetiology included relapsed eczema, erythroderma and a social construct. A total of 88.4% (107/121) agreed that TSW needs better understanding and more research. Respondents earlier in their careers are more cautious than senior respondents about prescribing TCS long term because of TSW, suggesting a trend that might lead to better understanding, communication and management.
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Affiliation(s)
| | | | - Celia Moss
- Birmingham Children's Hospital, Birmingham, UK
- University Hospital Birmingham, Birmingham, UK
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Shobnam N, Saksena S, Ratley G, Yadav M, Chaudhary PP, Sun AA, Howe KN, Gadkari M, Franco LM, Ganesan S, McCann KJ, Hsu AP, Kanakabandi K, Ricklefs S, Lack J, Yu W, Similuk M, Walkiewicz MA, Gardner DD, Barta K, Tullos K, Myles IA. Topical Steroid Withdrawal is a Targetable Excess of Mitochondrial NAD. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.17.24305846. [PMID: 38712043 PMCID: PMC11071640 DOI: 10.1101/2024.04.17.24305846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Background Topical corticosteroids (TCS) are first-line therapies for numerous skin conditions. Topical Steroid Withdrawal (TSW) is a controversial diagnosis advocated by patients with prolonged TCS exposure who report severe systemic reactions upon treatment cessation. However, to date there have been no systematic clinical or mechanistic studies to distinguish TSW from other eczematous disorders. Methods A re-analysis of a previous survey with eczematous skin disease was performed to evaluate potential TSW distinguishing symptoms. We subsequently conducted a pilot study of 16 patients fitting the proposed diagnostic criteria. We then performed: tissue metabolomics, transcriptomics, and immunostaining on skin biopsies; serum metabolomics and cytokine assessments; shotgun metagenomics on microbiome skin swabs; genome sequencing; followed by functional, mechanistic studies using human skin cell lines and mice. Results Clinically distinct TSW symptoms included burning, flushing, and thermodysregulation. Metabolomics and transcriptomics both implicated elevated NAD+ oxidation stemming from increased expression of mitochondrial complex I and conversion of tryptophan into kynurenine metabolites. These abnormalities were induced by glucocorticoid exposure both in vitro and in a cohort of healthy controls (N=19) exposed to TCS. Targeting complex I via either metformin or the herbal compound berberine improved outcomes in both cell culture and in an open-label case series for patients with TSW. Conclusion Taken together, our results suggest that TSW has a distinct dermatopathology. While future studies are needed to validate these results in larger cohorts, this work provides the first mechanistic evaluation into TSW pathology, and offers insights into clinical identification, pharmacogenomic candidates, and directed therapeutic strategies.
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Marshall HF, Leung DYM, Lack G, Sindher S, Ciaccio CE, Chan S, Nadeau KC, Brough HA. Topical steroid withdrawal and atopic dermatitis. Ann Allergy Asthma Immunol 2024; 132:423-425. [PMID: 38142858 DOI: 10.1016/j.anai.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Hannah F Marshall
- Children's Allergy Service, Evelina London, Guy's and St Thomas', National Health Service Foundation Trust, London, United Kingdom
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Gideon Lack
- Children's Allergy Service, Evelina London, Guy's and St Thomas', National Health Service Foundation Trust, London, United Kingdom; Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Sayantani Sindher
- Department of Medicine and Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Christina E Ciaccio
- Departments of Pediatrics and Medicine, The University of Chicago, Chicago, Illinois
| | - Susan Chan
- Children's Allergy Service, Evelina London, Guy's and St Thomas', National Health Service Foundation Trust, London, United Kingdom; Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Kari C Nadeau
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Helen A Brough
- Children's Allergy Service, Evelina London, Guy's and St Thomas', National Health Service Foundation Trust, London, United Kingdom; Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom.
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8
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Suzuki T. Diagnosing Beyond Bias: Differentiating Topical Steroid Withdrawal Syndrome From irAE-Induced Adrenal Insufficiency. Cureus 2023; 15:e50272. [PMID: 38196444 PMCID: PMC10774836 DOI: 10.7759/cureus.50272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/11/2024] Open
Abstract
Confirmation bias can impede accurate diagnosis. Since the approval of immune checkpoint inhibitors (ICIs), physicians are on high alert for newly developed immune-related adverse events (irAEs). Therefore, when patients present irAE-like symptoms, there is a risk of confirmation bias leading to overlooked diagnoses. This paper discusses a case of a patient with non-small cell lung cancer treated with nivolumab and topical dexamethasone ointment for an extended period due to oral mucocutaneous irAE. The patient developed adrenal insufficiency, initially considered to be a likely case of pituitary irAE. However, further investigation and the patient's clinical course revealed an unexpected diagnosis more in line with topical steroid withdrawal syndrome.
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Affiliation(s)
- Toshio Suzuki
- Department of Medical Oncology, University of Tsukuba, Tsukuba, JPN
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9
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Xue P, Qin H, Qin D, Liu H, Li J, Jin R, Xiao X. The efficacy and safety of oral microecological agents as add-on therapy for atopic dermatitis: A systematic review and meta-analysis of randomized clinical trials. Clin Transl Allergy 2023; 13:e12318. [PMID: 38146806 PMCID: PMC10694634 DOI: 10.1002/clt2.12318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/25/2023] [Accepted: 11/06/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a common skin disease that is hard to completely cure in a short time. Guidelines recommend the use of topical corticosteroids (TCS) as first-line anti-inflammatory therapy for AD, but long-term use has significant side effects. Microecological agents (MA), including probiotics, prebiotics and synbiotics, have been widely reported as a potential adjunctive therapy of AD, but whether MA can contribute to AD treatment is currently controversial. Therefore, we conducted a systematic review and meta-analysis to investigate whether MA as an add-on therapy for AD has synergistic and attenuated effects and to further understand the role of MA in clinical interventions for AD. METHODS We systematically searched Medline, Embase, Web of Science, Cochrane Library and PsycINFO databases up to Apr 11, 2023, and bibliographies were also manually searched, for potentially relevant studies regarding MA as additional therapy of AD. The Cochrane Risk of Bias Tool for assessing risk of bias was used to assess the quality of randomized controlled trials (RCTs). Two reviewers screened studies, extracted data, and evaluated the risk of bias independently. The primary outcomes (SCORAD scores and the number of adverse events) and the secondary outcomes (pruritus scores, the quality of life and the frequency of TCS) were extracted from each article. The data were combined and analyzed to quantify the safety and efficacy of the treatment. R (V4.4.3) software was used for data synthesis. The certainty of the evidence was evaluated with the Grade of Recommendation, Assessment, Development and Evaluation (GRADE) system. We also performed a trial sequential analysis to assess the reliability of the evidence. RESULTS A total of 21 studies, including 1230 individuals, were identified, 20 of which met the eligibility criteria for the meta-analysis. Our pooled meta-analyses showed that compared with controls, oral MA as an add-on therapy was associated with significantly lower SCORAD scores (MD = -5.30, 95% CI -8.50, -1.55, p < 0.01, I2 = 81%). However, adverse events, pruritus scores, quality of life, and frequency of TCS use showed no significant difference in this meta-analysis study (p > 0.05). CONCLUSIONS This meta-analysis showed that MA plus TCS could be an effective and safe treatment for patients with AD to relieve relevant symptoms, which might be used as an add-on therapy in the treatment of AD. However, due to the limited number of studies, results should be interpreted with caution. Further studies with a larger sample size are needed to explore the optimal protocol of MA plus TCS.
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Affiliation(s)
- Peiwen Xue
- School of Health Preservation and RehabilitationChengdu University of Traditional Chinese MedicineChengduSichuanChina
| | - Haiyan Qin
- Acupuncture and Tuina SchoolChengdu University of Traditional Chinese MedicineChengduSichuanChina
| | - Di Qin
- Acupuncture and Tuina SchoolChengdu University of Traditional Chinese MedicineChengduSichuanChina
| | - Huilin Liu
- Acupuncture and Tuina SchoolChengdu University of Traditional Chinese MedicineChengduSichuanChina
| | - Juan Li
- School of Health Preservation and RehabilitationChengdu University of Traditional Chinese MedicineChengduSichuanChina
- Affiliated Sichuan Provincial Rehabilitation Hospital of Chengdu University of TCMChengduSichuanChina
| | - Rongjiang Jin
- School of Health Preservation and RehabilitationChengdu University of Traditional Chinese MedicineChengduSichuanChina
| | - Xianjun Xiao
- School of Health Preservation and RehabilitationChengdu University of Traditional Chinese MedicineChengduSichuanChina
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10
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Spergel JM, Leung DYM. Topical steroid withdrawal syndrome: Should we worry? Ann Allergy Asthma Immunol 2023; 130:8. [PMID: 36596614 DOI: 10.1016/j.anai.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 01/02/2023]
Affiliation(s)
- Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
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